Mood problems at menopause

Depression is common and affects 1 in 5 women and 1 in 8 men at some stage of their lives (beyondblue). Depression usually responds well to treatment, but if untreated can be persistent.

At least half of those who recover from their first depressive episode will suffer additional episodes and 80% of those who have a history of two episodes of depression, will go on to have a further recurrence(1).

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Mood, depression and the menopause

Symptoms of depression

DSM-IV* Criteria for Major Depressive Disorder (MDD) (11) :

1. Depressed mood or irritable most of the day, nearly every day, as indicated by either subjective report (e.g. feels sad or empty) or observation made by others (e.g. appears tearful).

2. Decreased interest or pleasure in most activities, most of each day.

3. Significant weight change (5%) or change in appetite.

4. Change in sleep: Insomnia or hypersomnia.

5. Change in activity: Psychomotor agitation or retardation.

6. Fatigue or loss of energy.

7. Guilt/worthlessness: Feelings of worthlessness or excessive or inappropriate guilt.

8. Concentration: Diminished ability to think or concentrate, or more indecisiveness.

9. Suicidality: Thoughts of death or suicide, or has suicide plan.

* Criteria are unchanged in DSM5

Risk Factors for depression

(based on information from beyondblue)

Research suggests that continuing difficulties – long-term unemployment, living in an abusive or uncaring relationship, long-term isolation or loneliness, prolonged exposure to stress at work – are more likely to cause depression than recent life stresses. However, recent events (such as losing a job) or a combination of events can ‘trigger' depression in people who are already at risk because of past bad experiences or personal factors.

Personal factors

Specific risk factors in peri-menopausal women include

Treatment for depression

Key points

  • Depression is common in women and the time of the menopause transition may be one of greater risk for certain women.
  • Women in the menopause transition should be screened for clinically significant depression.
  • Management should be comprehensive, and address psychosocial stressors as well as menopausal symptoms.
  • Consider psychological therapies, pharmacotherapies and modalities which may improve the feeling of wellbeing and quality of life.

References

1. Burcusa SL, Iacono WG. Risk for recurrence in depression. Clinical psychology review. 2007;27(8):959-85.

2. Hickey M, Bryant C, Judd F. Evaluation and management of depressive and anxiety symptoms in midlife. Climacteric. 2012;15(1):3-9.

3. Gibbs Z, Kulkarni J. Risk Factors for Depression During Perimenopause. Women's Reproductive Mental Health Across the Lifespan2014.

4. Freeman EW. Associations of depression with the transition to menopause. Menopause (New York, NY). 2010;17(4):823-7.

5. Gibbs Z, Lee S, Kulkarni J. The unique symptom profile of perimenopausal depression. Clinical Psychologist. 2014.

6. Clayton AH, Ninan PT. Depression or menopause? Presentation and management of major depressive disorder in perimenopausal and postmenopausal women. Primary care companion to the Journal of clinical psychiatry. 2010;12(1):PCC.08r00747.

7. Maki PM, Freeman EW, Greendale GA, Henderson VW, Newhouse PA, Schmidt PJ, et al. Summary of the National Institute on Aging-sponsored conference on depressive symptoms and cognitive complaints in the menopausal transition. Menopause. 2010;17(4):815-22.

8. Judd FK, Hickey, M., Bryant, C. Depression and midlife: Are we overpathologising the menopause? J Affect Disord. 2011;Jan 24.

9. Ryan J, Burger HG, Szoeke C, Lehert P, Ancelin ML, Henderson VW, et al. A prospective study of the association between endogenous hormones and depressive symptoms in postmenopausal women. Menopause (New York, NY). 2009;16(3):509-17.

10. Bromberger JT, Kravitz HM. Mood and menopause: findings from the Study of Women's Health Across the Nation (SWAN) over 10 years. Obstetrics and gynecology clinics of North America. 2011;38(3):609-25.

11. American Psychiatric Association. DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS FOURTH EDITION. 2000.

12. Ayers B, Forshaw, M., Hunter, M.S. The impact of attitudes towards the menopause on women's symptom experience: a systematic review. Maturitas. 2010;65(1):28-36.

13. Will MA, Randolph JF. The influence of reproductive hormones on brain function in the menopausal transition. Minerva ginecologica. 2009;61(6):469-81.

AMS Empowering Menopausal Women

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Content created July 2014

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